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Focused cardiac ultrasound examination (FoCUS) is rapidly emerging for point-of-care cardiac assessment using hand-carried ultrasound (HCU) devices. A specific FoCUS protocol for horses and adequate training guidelines currently are not available.To gain knowledge about the training necessary to become proficient in performing FoCUS using a HCU device.Three healthy Warmblood horses were used for practical training of veterinarians and veterinary students in equine focused cardiac ultrasound (eFoCUS).Prospective educational study. An eFoCUS protocol and 1-day training course were developed. Pre- and post-course written tests were administered to participants to evaluate proficiency in knowledge of echocardiography and echocardiographic pathology. A post-course practical examination involved performing eFoCUS and storage of representative images. Images were evaluated using an image quality score and compared between participants with some practical experience and participants with no practical experience.Participants' knowledge of echocardiography increased significantly. Recognition of echocardiographic pathology pre-course ranged from 40% to 90% (mean score, 65.7%) and post-course from 85% to 100% (mean score, 92%). Eighteen of 21 participants were proficient in performing eFoCUS with a median image quality score of 79% (range, 42%-95%). Image quality did not differ between participants with some practical experience compared to participants with no experience.Veterinarians and veterinary students independent of previous experience can become proficient in performing eFoCUS after completion of a 1-day training course.

This article provides an overview on the principles of transthoracic echocardiography in horses. Indications for echocardiography, equipment, and technical considerations are discussed and a systematic approach for a complete echocardiographic examination in horses is described. Methods for assessment of chamber dimensions, allometric scaling of measurements, assessment of systolic and diastolic ventricular function, assessment of atrial function, hemodynamic assessment, and evaluation of valvular regurgitation are explained, focusing on traditional 2-dimensional (2D), motion-mode, and Doppler echocardiographic methods. Selected applications of newer echocardiographic methods, such as tissue Doppler imaging and 2D speckle tracking are also described.

Heart rate variability (HRV) analysis has been performed on ECG-derived data sets for more than 170 years but is currently undergoing a rapid evolution, thanks to the expansion of the human and veterinary medical technology sector. Traditional HRV analysis was initially performed to identify changes in vago-sympathetic balance, while the most recent focus has expanded to include the use of complex computer algorithms, neural networks and machine learning technology to identify cardiac arrhythmias, particularly atrial fibrillation (AF). Some of these techniques have recently been translated for use in the field of equine cardiology, with particular focus on improving the diagnosis of arrhythmias both at rest and during exercise. This review focuses on understanding the basic HRV variables and important factors to consider when collecting data for use in HRV analysis. In addition, the use of HRV analysis for the diagnosis of arrhythmias is discussed from human, small animal and equine perspectives. Finally, the future of HRV analysis is briefly introduced, including an overview of future developments in this rapidly expanding and exciting field.

Congenital heart disease should be considered when evaluating calves with chronic respiratory signs, failure to thrive, poor growth, or if a murmur is heard on physical examination. Echocardiography is currently the gold standard for diagnosing congenital heart defects. A wide variety of defects, either alone or in combination with a ventricular septal defect, are possible. A standardized approach using sequential segmental analysis is required to fully appreciate the nature and severity of more complex malformations. The prognosis for survival varies from guarded to poor and depends on the hemodynamic relevance of the defects and the degree of cardiac compensation.

Background Echocardiographic assessment of left ventricular (LV) size and function using area-based indices and volumetric estimates is not well established in horses. Objective To report reference intervals and measurement variability for uni-, 2-, and 3-dimensional echocardiographic indices of LV size and systolic function in Warmblood horses and to provide proof of concept for allometric scaling of variables to body weight. Unidimensional indices were to be compared to area-based indices and LV volume estimates to establish their clinical use. Animals Thirty healthy Warmblood horses and 70 Warmblood horses with a primary diagnosis of mitral regurgitation or aortic regurgitation. Methods Echocardiographic indices of LV size and systolic function were measured using an existing echocardiography database. Weight-related variables were scaled to body weight (BWT). Reference intervals and measurement variability were calculated, the influence of valvular regurgitation on LV size and function was investigated and agreement between different variables for detection of reduced, normal, and increased LV size and systolic function was assessed. Results Reference values for healthy Warmblood horses were reported. Measurement variability was sufficiently low for clinical use of all variables. Allometric scaling was effective to correct diastolic LV dimensions and cardiac output for differences in BWT. Various echocardiographic indices resulted in different conclusions regarding identification of LV enlargement and systolic dysfunction in healthy horses and horses with valvular regurgitation. Conclusions and clinical importance Echocardiographic assessment of LV size and systolic function should include joint assessment of multiple uni- and multidimensional indices. Area-based or volumetric indices that reflect LV long-axis motion should be included.

Background Assessment of cardiac electromechanical function in horses requires training, experience and specialised equipment and does not allow continuous monitoring over time. Objectives The objective of this study was to establish the use of an acoustic ECG monitor (Audicor® ) in healthy horses. It provides noninvasive, examiner-independent, continuous analyses combining ECG and phonocardiography to calculate indices of cardiac mechanical activity and haemodynamics. Device usability was investigated, reference intervals calculated and reproducibility of analyses assessed. Study design Prospective descriptive study. Methods Continuous overnight recordings were obtained in 123 healthy horses. ECG and acoustic cardiography analyses were performed. Electromechanical activating time (EMAT), rate-corrected EMATc, left ventricular systolic time (LVST), rate-corrected LVSTc and intensity and persistence of the third and fourth heart sound (S3, S4) were reported. Associations with age and reproducibility of analyses were assessed. Results Audicor® recordings of diagnostic quality were obtained in 116 horses, with an artefact-free recording time of 1:08-14:03 h (mean 10:21 h). 44.8% of the horses had atrial premature complexes (up to 0.18% of analysed beats), 4.3% had ventricular premature complexes (up to 0.021% of analysed beats). Reference intervals for acoustic cardiography variables were reported. S3 was significantly more often graded ≥5 (scale 0-10) in younger compared to older horses (P = 0.0036, R2 = 0.072). The between-day coefficient of variation ranged from 2.5 to 7.7% for EMAT, EMATc, LVST and LVSTc. Main limitations Audicor® algorithms are based on human databases. Horses were deemed clinically healthy without advanced diagnostics. Some data were lost because of technical difficulties, artefacts and noises. Conclusions Overnight Audicor® recordings are feasible in horses. Combining ambulatory ECG and phonocardiography allows noninvasive, continuous assessment of variables representing systolic and diastolic cardiac function. ECG rhythm analyses require over-reading by a specialist, but acoustic cardiography variables are based on automated algorithms independent of examiner input. Further studies are required to establish the clinical value of acoustic cardiography in horses.

Background Assessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease. Objectives To describe the use of pulsed-wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease. Animals Thirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD. Methods Echocardiograms were retrospectively analyzed. Reference intervals were calculated. PW TDI indices of healthy horses and horses with MR, AR, and MD were compared by one-way ANOVA and Dunnett's test. Results A complete set of PW TDI variables could be obtained in 94 of 101 horses. Variables corresponding to isovolumic intervals were most difficult to measure. Valvular regurgitation influenced variables describing isovolumic contraction and ejection. Horses with MD had significantly shortened ETm (−118.5 [−154.1 to −82.9] ms; mean difference [95% CI of difference of means]), increased PEPm/ETm (0.11 [0.05 to 0.17]), prolonged IMPm (0.28 [0.18 to 0.37]), increased S1 (8.9 [5.2 to 12.6] cm/s), and decreased E1 (−2.6 [−4.7 to −0.5] cm/s), Em (−14.2 [−19.9 to −8.5] cm/s), and Em/Am ratio (−1.6 [−2.6 to −0.6]). Conclusions and Clinical Importance Pulsed-wave TDI might be useful for detection of LV dysfunction in horses with primary MD. The clinical value of TDI in horses with MR and AR remains uncertain.

To assess the influence of 2nd-degree AV blocks (AVB) on RR interval-based heart rate variability (HRV) variables; to investigate the effect of using PP interval time series and of artifact filtering on HRV analyses; to investigate the influence of electrocardiogram (ECG) recording length and time of recording; and to calculate day-to-day variability and reference intervals of HRV variables.Thirty healthy adult horses.RR and PP interval time series were extracted from 10-h Holter ECGs and an automated filter was applied to the RR time series (RRf). Time-domain HRV variables were calculated based on RR, PP, and RRf time series and their relation to the number of AVBs was assessed. Hourly 10- and 60-min segments were extracted to investigate the influence of segment length and recording time on HRV variables. Day-to-day variability and reference intervals of HRV variables were calculated.Variables of short-term HRV were significantly influenced by the number of AVBs when based on RR, but not when based on PP- and RRf time series. PP- and RRf-based HRV variables were in good agreement. The majority of HRV variables were influenced by recording time and ECG segment length. Day-to-day variability of HRV variables was low when based on 10-h ECG recordings but moderate to high when based on 60-min and 10-min recordings.Second-degree AVBs significantly influence conventional RR-based, but not PP- and RRf-based time-domain HRV variables. However, PP and RRf analyses have limitations and recording length and time of recording must be considered.

Objectives To investigate the relationship of heart rate (HR) and ECG time intervals to body weight (BWT) in healthy horses and ponies. We hypothesized that HR and ECG time intervals are related to BWT. Animals 250 healthy horses of >30 breeds; 5.5 (1–30) y [median (range)]; 479 (46–1018) kg. Methods Prospective study. Standard base-apex ECGs were recorded while the horses were standing quietly in a box stall. Mean HR over 15 s was calculated and RR interval, PQ interval, QRS duration, and QT interval were measured by a single observer.QT was corrected for differences in heart rate using Fridericia's formula (QT cf = QT/ 3 √RR). The relationship between ECG variables and BWT, age, sex, and RR interval was assessed using multivariate backward stepwise regression analyses. Goodness of fit of the model was improved when using log(BWT) compared to BWT. Body weight was overall the strongest predictor of HR and ECG time intervals. Therefore, only log(BWT) was included as an independent variable in the final model. The level of significance was p = 0.05. Results HR ( R 2 = 0.21) showed a significant negative relationship and PQ ( R 2 = 0.53), QRS ( R 2 = 0.23), QT ( R 2 = 0.14), and QT cf ( R 2 = 0.02) showed significant positive relationships to log(BWT). Conclusions Small equine breeds undergoing routine ECG recordings have slightly faster heart rates and shorter ECG time intervals compared to larger equine breeds. Although the magnitude of absolute differences may be small, body weight needs to be considered among other factors when comparing HR and ECG time intervals to normal ranges in horses.

Objective—To determine pharmacokinetic variables and to evaluate the influence on clotting times after SC administration of single doses of dalteparin and enoxaparin to horses. Animals—5 healthy adult horses. Procedure—The study was designed as a 4-period crossover study. Each horse received a single SC injection of dalteparin (50 and 100 anti-Xa U/kg) and enoxaparin (40 and 80 anti-Xa U/kg). Plasma anti-Xa activities and clotting times were measured, and pharmacokinetic variables were determined. Absolute and relative maximal prolongation of clotting times was calculated, and correlation between plasma anti-Xa activities and clotting times was determined. Results—The SC administration of each of the doses of the 2 preparations was well tolerated. Time course of the anti-Xa activities could be described in a 1-compartment model. Comparison of low- and high-dose treatments revealed a disproportionate increase of the area under the plasma activity-time curve and prolongation of the terminal half-life, but the increase in maximum plasma activity was proportionate, and peak plasma concentrations corresponded with concentrations recommended in human medicine. There were only mild changes in activated partial thromboplastin time (aPTT), whereas the influence on thrombin time (TT) was greater, dose-dependent, and more variable. A weak-to-moderate correlation between aPTT and plasma anti-Xa activities and a moderate-tostrong correlation between TT and plasma anti-Xa activities were found. Conclusion and Clinical Relevance—Pharmacokinetic and anticoagulatory properties of low-molecular- weight heparins in horses are similar to those found in humans. Once-daily SC administration of dalteparin or enoxaparin may be useful as an anticoagulatory treatment in horses. (Am J Vet Res 2002; 63:868–873)

Quinidine is effective for treatment of atrial fibrillation (AF) in horses, but often accelerates ventricular response rate. Diltiazem effectively controls heart rate response to AF in other species. This investigation determined the effects of diltiazem on cardiac rate and rhythm, left ventricular (LV) function, central hemodynamics, and peripheral blood flow in normal, standing, nonsedated horses. A dose-finding study was performed. Afterward, 8 healthy horses were treated with diltiazem IV every 30 minutes to achieve cumulative dosages of 0 (saline control), 1, 1.5, and 2 mg/kg. Plasma diltiazem concentration, heart rate and rhythm (by electrocardiography), LV function and central hemodynamics (by cardiac catheterization), LV dimensions (by echocardiography), and forelimb blood flow (by Doppler sonography) were determined during each treatment period. Diltiazem plasma concentrations between 390 and 910 ng/mL were achieved, with considerable variation among horses. Cardiac effects of diltiazem included intermittent depression of the sinus and atrioventricular (AV) nodes and mild impairment of systolic and diastolic LV function. Vascular effects of diltiazem included arterial vasodilatation, increased limb blood flow, and decreased systemic vascular resistance. Baroreceptor reflex-mediated sympathetic activation increased sinus node rate and presumably blunted the depressive effects of diltiazem on myocardial and nodal tissues. Two horses developed transient high-grade sinus arrest with severe systemic hypotension. Diltiazem appears relatively safe in healthy horses, but dosage may be limited by hypotension from vasodilatation and direct suppression of sinus node discharge. Because of its inhibitory effects on AV nodal conduction, diltiazem may prove useful for heart rate control in horses with AF.

Background Assessment of left ventricular (LV) systolic function can be achieved by conventional echocardiographic methods, but quantification of contractility, regional myocardial function, and ventricular synchrony is challenging. The goal of this study was to investigate the applicability of two-dimensional speckle tracking (2DST) to characterize segmental and global wall motion for assessment of LV function and LV synchrony in healthy goats. We aimed to describe the techniques, report normal values of a variety of 2DST indices, and determine the influence of general anesthesia. Methods Prospective study on 22 healthy female Saanen goats (3.7 ± 1.1 y, 60.2 ± 10.5 kg [mean ± SD]). All goats underwent two transthoracic echocardiographic examinations, the first standing and unsedated and the second 7.4 ± 3.5 days later during isoflurane anesthesia and positioned in sternal recumbency. Data analyses were performed offline, blinded, and in random order. Left ventricular longitudinal, radial and circumferential strain and strain rate as well as longitudinal and radial displacement were measured using 2DST methods. Summary statistics were generated and differences of 2DST variables between myocardial segments and treatments (i.e., awake vs. anesthetized) were assessed statistically (alpha level=0.05). Results Echocardiographic analyses by 2DST were feasible in all goats and at both time points. Longitudinal systolic strain, strain rate and displacement followed a gradient from apex to base. Absolute systolic strain was generally lower and strain rate was higher in awake goats compared to anesthetized goats. Circumferential and radial indices did not consistently follow a segmental pattern. Generally, peak strain occurred later in anesthetized goats compared to awake goats. General anesthesia did not significantly influence LV synchrony. Conclusions 2SDT is a valid method for non-invasive characterization of LV wall motion in awake and anesthetized goats. The results of this study add to the understanding of LV mechanical function, aid in the diagnosis of global and segmental LV systolic dysfunction, and will be useful for future cardiovascular studies in this species. However, effects of anesthesia and species-specific characteristics should be considered when goats are used as animal models for human disease. Electronic supplementary material The online version of this article (doi:10.1186/s12947-015-0005-8) contains supplementary material, which is available to authorized users.